4. INITIAL DETERMINATION PAB-0191.PDF
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MARICOPA COUNTY DEPARTMENT OF TRANSPORTATION 2901 W. Durango Street « Phoenix, AZ 85009 Phone: (602) 506-4178 PATENT EASEMENT ABANDONMENT INITIAL DETERMINATION Contact Information Applicant Name: Samuel Blackman Mailing Address: 17414 N 39th Ave City: Glendale State; AZ Zip: 85308 Phone (602 )- 448 - 9556 Email: Samuelmblackman@gmail.com Parcel Detail Assessor's Parcel Number: 202. - 13 - 056D 1. Location of Request: (ex: 3200 W. Dove Valley Road, Phoenix) 464xx N 38th Ave New River, AZ 85087 2. Description of Request: (ex: Abandon Easement bordering the South side of parcel 123-45-067A) Abandon ali Easements of parcel 202-13-056D 3. Access Certification: I certify, under penalty of perjury, that no loss of currently existing legal and physical access to any property will occur if the County grants the patent easement abandonment requested in this initial determination. Signature ALLL. 12/6/2021 Signature of Applicant Date Maricopa County Use Only PAB Number: Initial Determination Fee*: $250.00 Check #: ce. $ 9614942 12% Total Received: i260. 0 Date: \z/b/z i Rec'd By: C je * The Initial Determination fee is NOT refundable. Make checks payable to: MCDOT 2901 West Durango Street Phoenix, AZ 85009. Permit Receipt Payer Name: SAMUEL BLACKMAN 17414 N 39TH AVE GLENDALE, Arizona 85308 Payment Items Description PATENT EASEMENT // APN 202-13-056D // 1X $250.00= $250.00 Maricopa County Department of Transportation 2901 W. Durango Street Phoenix, AZ 85009 Receipt #: 100852 Payment Date: 12/6/2021 Reference #: APN 202-13-056D Receipt Type: Patent Easements Payment Type Transaction # Amount Credit Card 3819592723 $250.00 Total: $250.00 MCDOT Permits Thank you for your payment. Please print this receipt and keep it for your records. Maricopa County Department of Transportation Clerk ID: RHODESC Customer Name: SAMUEL BLACKMAN Reference Number : APN 202-13-056D Product Description Payment Amount Patent Easements 4 $250.00 Payment Amount: $250.00 Receipt Number: 3819592723 Transaction Date: 12/06/2021 12:42 PM Payment Type: Account a / (7 x | agree to pay this obligation according to the terms outlined in my agreement with my card issuer.